Herbert M Hedberg, MD1, Michael B Ujiki, MD2. 1University of Chicago Medical Center, 2NorthShore University HealthSystem
Anti-reflux mucosectomy (ARMS) is a relatively new surgical procedure that was discovered after the observation that individuals who had a gastroesophageal junction mucosectomy for Barrett’s Esophagus also had improvement in symptoms of gastroesophageal (GE) reflux. The procedure is an endoscopically performed, hemi-circumferential mucosectomy of the GE junction. In retroflexed position, 1cm distal esophageal mucosa and 2cm proximal gastric mucosa are resected. The resection should be 240-270 degrees around the GE junction, sparing the gastric flap valve toward the greater curve of the stomach.
Contraction and scarring of the resected area likely tightens the flap valve to improve reflux symptoms. Since ARMS does not address reflux due to a malpositioned lower esophageal sphincter, it should only be performed upon individuals confirmed not to have a hiatus hernia. Short-term outcomes in available case series are encouraging, but no long-term results are yet available.
As of yet, the few case reports and series describing ARMS have utilized endoscopic submucosal dissection or cap-technique endoscopic mucosal resection (EMR) to perform the mucosectomy. This video submission demonstrates ARMS using submucosal injection and band-technique EMR. Banding provides better visualization and decreased risk of perforation as compared to cap-EMR, and is simpler to perform in a retroflexed position than standard submucosal dissection. In this demonstration, a 270 degree resection is completed in 17 minutes using 5 bands. ARMS is a low-morbidity, outpatient option for individuals with reflux, and band-EMR is a safe and user-friendly technique that may facilitate the procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87831
Program Number: V141
Presentation Session: Flexible Endoscopy Videos Session
Presentation Type: Video
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